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3 Patients behavior Health behavior around the world appears irrational –It is not consistent with a model where patients invest in treatment or prevention until benefits and costs are equal But consistent ways in which people deviate from this model –Poor spend a lot of money on health –Most on acute care, little on long term care or prevention –Demand is very sensitive to price –Demand is very sensitive to distance Lack of money and knowledge are constraints but on their own do not fully explain health behavior Not just an issue for poor, in rich countries people do not: –Complete their courses of antibiotics, –Take iron pills –Wash hands

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6 Implications: health worker reliability Challenge is reliable, objective monitoring Cell phones potential monitoring tool Important that it not just be a monitoring tool Objective monitoring allows incentives Testing can help calibrate incentives for reliability

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7 Applying the Lessons: X out TB Increased compliance with TB drug regimes critical to health and preventing spread of MDRTB TB compliance classic example of patient and health worker problems failures –Benefits are a long way off, pain is now –DOTS relies on reminders by health works, often unreliable X out TB seeks to solve this by –Reminderphone rings to remind patient to take pill –Monitoringurine strips generate code if patient has been taking their meds) –Less reliance on workersmonitoring done by patient and phone –Deadlinepatient enters code by SMS before deadline –Up front incentivespatient receives free minutes if correct code entered before deadline Testing can calibrate size of incentives needed for compliance